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Paperwork Reduction Act Notice
<br />Puhi:c re: /.rlint, hunlrn Inr rir: •- ~~~I~Cn of iniprmatum iv r;ilir ~a l.vl 1•. - r-'.~~ ,
<br />...; :'ar} ... .. ray:tee 1;} IU hCUfS a5 aG
<br />~ everaee per response for some minor facilities, [p 110 hours as an averaee per resnoncr For some major facilities,
<br />~ web a we:ehled average for major and minor facilities of IS hours per response, includine time for reviewing
<br />~ instructions, searching existing data sources, nathering and maintaining the data needPrl, y,,i cump!etipg and ~
<br />reviewmg the collection of information. Send mmmenle reeardine the burden ecti male ur "~~ other ~ err „r
<br />, r.~....
<br />j this collection of information, including suggestions for reducing thie burden, to Chief, L~for-..,a[iun Policy ~~
<br />Branch, PM-223, U.S. Environmental Protectiop Agency, 401 M Street, SW Waslunglup, DC 20460; apd to the
<br />', Office of Infortnauop end Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
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<br />General Instructions
<br />1. If form has beep partially completed by preprinting, disregard instructions directed a, cn;ry of t.`,a: i.-..fo.-e'ticr;
<br />alrrady preprinted.
<br />2. Enter 'Permd(ee h'mne,'Alailing Address (and facility name location, if different)," "Permit h'unrhvr " gnrt
<br />"Discharge Number" w~herc indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending ",Lfanitr:nnq Pcnud" covered by form whue indicated.
<br />4. Enter each "Parumeter" as speciGcd :n monitoring rrquiren:cnb o(pennil
<br />5. Enter ".Sample .1leasurena•nP' data (or each parameter under "4Juanorv" and '~Oucntti" in units specii;,:d in permit.
<br />".dveraRe" is normally anthmetic avcragc (gcomelnc average for bacterial parameters) of all sample mcasurcmen[s
<br />fur each parameter obGlined during "iVumiurmx Period": ".1/uxnuwn" and ",IGninnun" arc nur~ially exlrente high
<br />and toe measurements obtained during "tloniluring Period." (~.\ctc to mumcipals with stxondary treatment
<br />rcyuircmcm. Emcr l(`-day avcragc of sampic nu:asurcments untie: ".•ioc agr," and enter nic:.i:~ '.. -. 7aa} avcragc
<br />of sample mtasuremcnls pbLtined during monitoring period under'4~lnxirunr. ")
<br />6. Enter "Perms! .Requrrernen!" for cash parameter under "Ouonritj"and "Quolih" ns specified :, permit.
<br />7. Under "A'o ~" c.^,tcr ,,^,u;nber cf sample m'ws;r.-.:cn[s during monitoring period that c..cccd maximum (and,ror
<br />nummum or iildy avcragc as apprupnalc) pauut rcyl.i~uucnt for each par:uue!c:. If uone, auu "0".
<br />n. Euicr "iverlueuep uj Anuit~i~" uuilr a~ ".\'mnpie .iiru.vu'rurui" (aCiual iicy ucr,~} of SniirpLng siid ar:aty$i$ uSCu
<br />dnnng mondonng penod) and as "Penni! Requiremrn(" specified in permit (c g., Enter "Con(," for continuous
<br />mom;w.cg, ., 1, ~,: ro, „cc ...~~ rc, ,,._,.. ~ ^" for cote c.:, p.., ,,,.,,, '^' :.,. ,,::,; day per quanc . •" )
<br />9. Enter ".Sample ) Ipe' both as "~'nnrple 1lrasurement" (actual sample ; ~c used durng momtonng pencil! ::no as
<br />"/'ermrt Requirrmen!," (c g., Enter "Urnh" for individual sample, "7tH("' for 21-hour compostlc, "A' a" for
<br />couiutuwu mowionug, cic.)
<br />10. Where violations of permit requirements are reported, attach a brief explanauon to describe cause and corrective
<br />actions taken, and reference each violation b} date.
<br />I I. If "no discharge" occurs during monitoring penod, eater ",No Discharge" across form in place oC data entry.
<br />l2. Enter "Namerl'itle ojPrincipal Executive O~cei' with "Signature ojPrincipnl Executive D~cer ojAulhorized
<br />Agent," "Telephone Number," and "Dale" at bottom of Corm.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Afonitoring Report (DAIR) form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />71tis report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can
<br />result in civil penalties not to exceed S 10,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 08-95)
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